REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
August 9, 2022
FROM
WILLIAM L. GILBERT, Director, Arrowhead Regional Medical Center
SUBJECT
Title
Appropriation Adjustment to Fund Multiple Medical Information Technology, Inc. Agreements for the Legacy Electronic Health Record System
End
RECOMMENDATION(S)
Recommendation
1. Approve an increase of appropriation to Contract No. 01-160 with Medical Information Technology, Inc. in the amount of $2,428,552, for continued use and maintenance of the legacy electronic health record system for 24 months during conversion to the new Epic electronic health record system, with no change to the contract term beginning March 30, 2001, and continuing until terminated by either party.
2. Approve an increase of appropriation to Contract No. 06-438 with Medical Information Technology, Inc. in the amount of $165,528, for continued use and maintenance of the legacy electronic health record system for approximately eight months during conversion to the new Epic electronic health record system, with no change to the contract term beginning November 30, 2006, and continuing until terminated by either party.
(Presenter: William L. Gilbert, Director, 580-6150)
Body
COUNTY AND CHIEF EXECUTIVE OFFICER GOALS & OBJECTIVES
Provide for the Safety, Health and Social Service Needs of County Residents.
FINANCIAL IMPACT
Approval of this item will not result in the use of Discretionary General Funding (Net County Cost) as the additional total not-to-exceed amount of $2,594,080 is funded by State Medi-Cal, Federal Medicare, private insurances, and other department revenue. Funding sources may change in the future pending any legislative actively related to the repeal and/or replacement of the Affordable Care Act. Adequate appropriation and revenue are included in the Arrowhead Regional Medical Center’s (ARMC) 2022-23 budget and will be included in future recommended budgets.
BACKGROUND INFORMATION
Approval of the recommendations will provide ARMC with sufficient appropriations to fund the costs associated with continued use and maintenance of the Medical Information Technology, Inc. (MEDITECH) electronic health record (EHR) system , while ARMC continues to transition to Epic, the new EHR system. ARMC has utilized the MEDITECH EHR system for all patient care and billing needs since 2001. MEDITECH provided ARMC a comprehensive and integrated EHR system that was designed to help increase patient safety, streamlined processes, and improve communication across departments and care teams. MEDITECH Business Clinical Analytics integrated with the MEDITECH EHR system environment to extract analytical data and present it in a standardized manner.
ARMC began transition to Epic, the new EHR system, in February 2022, and has begun to sunset clinical portions of the MEDITECH EHR system. Non-clinical modules, which ARMC uses within MEDITECH to manage billing, patient accounts, general ledger and fixed assets, will need to remain active. The requested increase in appropriation is to pay for the licensing and support for these non-clinical modules as Epic does not currently offer functionally for general ledger and fixed assets; these MEDITECH modules will remain active until available in the Epic system and will be transitioned at that time. ARMC is submitting a separate Board Item for approval on August 9, 2022 to reduce the number of clinical modules that are no longer necessary from MEDITECH.
The majority of the MEDITECH modules are expected to be transitioned to Epic by December 2022. Modules specific to scanning and archiving of medical records may take longer to convert and will remain active until full transition to Epic is completed and transfer of the medical record data and billing has been verified. Modules specific to billing and patient accounts will take longer to transition to Epic and will remain active until complete billing functionality is available in Epic.
Between March 6, 2001 and August 24, 2010, the Board of Supervisors (Board) approved the following actions for various MEDITECH services (including purchases, installation, and expenses):
|
Contract No. |
Board Approval Date |
Item No. |
Services Provided |
|
01-160 |
3/6/2001 |
65 |
Purchase and installation of the EHR system at ARMC |
|
01-160 A-1 |
1/28/2003 |
87 |
Purchase and installation of Siemens’ Picture Archival Communications System interface |
|
01-160 A-2 |
5/6/2003 |
65 |
Additional seven modules added |
|
01-160 A-3 |
12/14/2004 |
54 |
Additional three modules added |
|
06-438 |
6/6/2006 |
100 |
Additional eight modules added |
|
01-160 A-4 |
5/19/2009 |
63 |
Additional software and interfaces added |
|
01-160 A-5 |
8/24/2010 |
11 |
Additional interface added |
Since 2001, an average of $1,198,741 has been expended for all MEDITECH modules annually, which includes a contractual inflationary factor of a maximum of 6%, assessed annually. Over the years, MEDITECH EHR system modules were added and additional statements of work were executed. However, these additions should have been clearly identified and executed as amendments to the original Contract, No. 01-160, but were executed by the Purchasing Agent since August 2010. As a result, there was a lack of continuity due to multiple purchase orders and staff turnover which led to a lack of cumulative spend tracking. An increase in the contract appropriations is now needed to ensure that ARMC has sufficient funding to maintain certain aspects of the MEDITECH EHR system following ARMC’s transition to Epic.
The Board Agenda Items approving Contract Nos. 01-160 and 06-438 and related amendments specify expected total expenditures for set periods of time. However, both of these contracts have a perpetual term, and allow MEDITECH to increase the contract amounts on an annual basis. Accordingly, MEDITECH has rejected ARMC’s request to amend the contracts to reflect an increase to the Board approved contract amounts on the basis that the contract terms already allow MEDITECH to increase the fees and continue to bill the County. Therefore, ARMC is now requesting that the Board approve the requested appropriation increase to the contracts, without an amendment, to ensure that there is sufficient funding to transition and maintain needed modules of the MEDITECH EHR system.
PROCUREMENT
The County Purchasing Department continues to support the non-competitive contracts with MEDITECH based on ARMC’s existing contracts.
REVIEW BY OTHERS
This item has been reviewed by County Counsel (Bonnie Uphold, Supervising Deputy County Counsel, 387-5455) on August 2, 2022; Purchasing (Ariel Gill, Buyer, 777-0722) on May 23, 2022; ARMC Finance (Chen Wu, Finance and Budget Officer, 580-3165) on May 24, 2022; Finance (Jenny Yang, Administrative Analyst, 387-4884) on June 10, 2022; and County Finance and Administration (Diana Atkeson, Deputy Executive Officer, 387-5423) on May 25, 2022.